Illuminated Endoscopic Pedicle Probe With Replaceable Tip

ABSTRACT

An endoscopic pedicle probe for use during spinal surgery to form a hole in a pedicle for reception of a pedicle screw has an enlarged proximal end for cooperation with the hand of the surgeon and an elongate shaft terminating in a distal tip that may be pushed through the pedicle to form the hole. The tip may be detachable for replacement. An endoscope extends through the shaft and is connected with a monitor to enable the surgeon to visually observe the area being treated. In a preferred form a light means extends through the shaft to illuminate the area being treated, and in a further preferred form a conduit extends through the shaft to convey a fluid to flush the area being treated. In a further embodiment, two endoscopes are associated with the probe.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/728,987, filed Dec. 27, 2012, which claims priority to and thebenefit of U.S. Provisional Patent Application No. 61/647,747, filed May16, 2012, the entire contents of which are incorporated by referenceherein.

FIELD

This invention relates generally to surgical instruments. Morespecifically, the invention relates to a pedicle probe for use informing holes in a vertebral pedicle in preparation for pedicle screwinsertion. According to one feature of the invention, the probeincorporates at least one endoscope to enable the surgeon to see thearea being treated. According to another feature, the probe has a lightto illuminate the area being treated, and according to a furtherfeature, the probe has a replaceable tip on its distal end. According toa still further feature, the probe has a channel for directing aflushing fluid to the area being treated to maintain a clear field ofvision for the endoscopic camera. The probe of the invention may haveany one or any combination of these features.

BACKGROUND

It is sometimes necessary to perform surgery on the spine in order torepair trauma, correct a deformity, or alleviate the effects of disease.Spinal fusion or stabilization is one procedure that may be employed totreat these conditions. According to one source, at the present timethere are approximately 30 million spine procedures performed globallyeach year, including approximately 400,000 cervical and lumbar fixationsperformed in the US.

Spinal fusion may be accomplished by insertion of screws into thepedicle to stabilize a spinal segment. The pedicle is a dense, stem-likestructure projecting from the posterior of a vertebra, and there are twopedicles per vertebra that connect to other structures. Since thepedicle is the strongest point of attachment of the spine, significantforces can be applied to the spine without failure of the bone-to-metalconnection.

To insert pedicle screws, a long, thin, metal probe is inserted throughthe pedicle and into the vertebral body, forming a hole for reception ofthe screw. Conventional pedicle probes may be straight or curved, andcomprise an elongate solid metal shaft with an enlarged hand grip on theproximal end. The probe may have a shaped distal end adapted for forminga hole through the pedicle, or a separate awl or reamer may first beused to form a hole through the pedicle, and the probe then insertedinto the cancellous bone of the pedicle and into the vertebral body todevelop a path for the screw.

A variety of probes are known in the prior art, including the so-calledgear shift pedicle probe and the Fox pedicle probe. The gear shift probehas a round head on its proximal end, whereas the Fox probe has a flatdisc-shaped head on its proximal end.

Conventional modalities used to approximate or simulate screw placementare indirect, and include fluoroscopic guidance and framelessstereotactic guidance. Approximations of the pedicle and surroundingvital structures are obtained from a CT scan or MRI done prior tosurgery.

Proper positioning of a conventional probe depends to an extent upontactile feel. For instance, advancement of the probe should be smoothand consistent. A sudden plunge suggests breaking out of the pediclelaterally, and an increase in resistance indicates abutment against thepedicle or vertebral body cortex.

These conventional modalities require a steep learning curve, andimproper or inaccurate manipulation of the probe and placement of thepedicle screw can result in caudal or medial penetration of the pediclecortex and dural or neural injury.

With conventional pedicle probes there is no direct way to confirm thatthe hole was made within the pedicle and that the screw will be placedcompletely inside the pedicle. Surrounding structures can be injured ifa portion of the screw is placed outside of the pedicle. There can benerve root injury, epidural vessel injury, or spinal fluid leakagecaused by a misplaced screw.

Applicant's earlier U.S. Pat. No. 6,855,105, discloses an endoscopicpedicle probe having a camera at its distal end connected with anendoscopic monitor via a fiber optic bundle extending through the probeto provide the surgeon with a view of the area being treated, thusovercoming many of the shortcomings of conventional pedicle probes.

Notwithstanding the advantages of applicant's earlier pedicle probe,illumination of the area being treated would greatly enhance use of theprobe. Currently, there are no pedicle probes having any means toilluminate the pedicle.

Additionally, the distal tip of the probe can become worn or damagedduring use, rendering the whole instrument unusable or reducing itsusefulness. Further, in some instances a tip having differentcharacteristics may be desired. A replaceable tip enables this to beachieved without having to replace the entire instrument. Further, bodyfluids and debris can accumulate at the area being treated, blocking ordegrading the view provided by the endoscope. It would be desirable tohave a means to flush these fluids and debris away from the area beingtreated to maintain a clear field of view for the endoscope camera.

Accordingly, there is need for a system and method for insertion ofpedicle screws which eliminates the guesswork and error-prone modalitiesof the prior art. In particular, there is need for a system whichprovides the surgeon with direct visual confirmation during the surgicalprocedure that the pedicle probe is in the right position for forming ahole for proper placement of the pedicle screw. Further, there is needfor a pedicle probe having a removable distal tip that can be replacedwhen necessary or desired. Still further, there is need for a pedicleprobe having means for illuminating the area being treated.Additionally, there is need for a pedicle probe having means fordirecting a fluid to the area being treated to remove body fluids anddebris that might otherwise obscure the area.

SUMMARY

The present invention comprises a pedicle probe having means associatedwith it to enable the surgeon to directly confirm the location of theprobe during a surgical procedure. More specifically, the inventioncomprises a pedicle probe which provides the surgeon with a visualindication during a surgical procedure of the position of the proberelative to the pedicle and surrounding structure, and which, inaccordance with one aspect of the invention, has means to illuminate thepedicle. In accordance with another aspect of the invention, the distaltip of the probe is replaceable and may be disposable. In a furtheraspect of the invention, the probe has means associated with it to flushthe area being treated to wash away body fluids and debris that wouldotherwise obscure the field of vision.

In particular, the probe of the invention is an endoscopic probe havingan elongate shaft with a reduced diameter tip on its distal end. Acamera at the distal end is connected with an endoscopic monitor via afiber optic bundle extending through the shaft, and depending upon thepositioning of the camera and the lens employed, the probe of theinvention affords the surgeon direct views of the area being treated,ranging from 0° to 90° relative to the longitudinal axis of the probeshaft, depending upon the positioning of the endoscope camera.

In a preferred embodiment, a light is associated with the probe forilluminating the area being treated.

In another preferred embodiment, the distal tip can be threaded orotherwise securely removably attached to the forward or distal end ofthe shaft so that the tip can be replaced when worn or damaged or when atip having different characteristics is desired.

In a further preferred embodiment, means is provided on the probe forflushing the area being treated with a fluid, such as, e.g. saline, toremove body fluids and debris that might otherwise obscure the view.

In one example of the invention, a Fox probe is modified to have ahollow shaft and a small endoscope is placed in the hollow shaft, with acamera positioned at the distal end and connected via a fiber opticbundle with an endoscopic monitor to afford either a 0°, a 45°, or a 90°view, depending upon the lens employed and the positioning of thecamera.

The endoscopic pedicle probe of the invention puts the surgeon “in thepedicle” with the use of endoscopy. The positioning of the probe can bedirectly and accurately determined during surgery, and there is noquestion as to whether the screw will be too medial, lateral, cranial,caudal, or deep. The surgeon will know if the wall of the pedicle hasbeen breached, and to what extent. He or she can then decide to use theplanned trajectory even if there is a small breach of the pedicle wall.The probe of the invention provides the surgeon with knowledge of howmuch of an intrusion exists, and he or she can ascertain if criticalstructures will be in danger from screw placement. The surgeon can alsoavoid parallax that may cause errors when using fluoroscopic guidance.

Further, a probe must be used in any event to perform spinal fusions,and the probe of the invention will not represent an additionalinstrument needed for pedicle screw placement. Accordingly, there willbe no additional costs or equipment needed to perform the standardspinal fusion.

The probe of the invention can be utilized in the cervical spine forlateral mass screw placement, pedicle screw placement, ortrans-articular screw placement. It can be used in the thoracic, lumbar,and sacral spine for pedicle screw placement and trans-laminar screwplacement, and can be used in standard open spine fusion or in minimallyinvasive percutaneous spine fusion.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing as well as other objects and advantages of the inventionwill become apparent from the following detailed description whenconsidered in conjunction with the accompanying drawings, wherein likereference characters designate like parts throughout the several views,and wherein:

FIG. 1 is a somewhat schematic perspective view of an endoscopic pedicleprobe according to the invention, in combination with an endoscopymonitor.

FIG. 2 is a side view in elevation of a conventional pedicle probe onwhich the present invention can be based.

FIG. 3 is a longitudinal sectional view of a first embodiment ofendoscopic pedicle probe according to the invention.

FIG. 4 is an enlarged, fragmentary, longitudinal sectional view of thedistal end of the endoscopic pedicle probe of FIG. 3, depicting a 90°lens orientation.

FIG. 5 is a view similar to FIG. 4, but showing a 45° lens orientation.

FIG. 6 is a view similar to FIG. 5, but showing a 0° lens orientation.

FIG. 7 is an axial view of a pedicle.

FIG. 8 is a sagittal view of a pedicle.

FIGS. 9 and 10 are fragmentary perspective views depicting how a pedicleprobe is used to form a hole in a pedicle.

FIGS. 11-14 are somewhat schematic views depicting the progressive stepsin forming a hole in the pedicle using the pedicle probe.

FIG. 15 is an enlarged fragmentary isometric view of the distal end ofone embodiment of pedicle probe according to the invention, showinglight means for illuminating the pedicle.

FIG. 16 is an enlarged fragmentary isometric view of the distal end ofone embodiment of pedicle probe according to the invention, showing aremovable tip.

FIG. 17 is a side view in elevation of another embodiment of pedicleprobe according to the invention.

FIG. 18 is a side view in elevation of the probe of FIG. 17, taken at 90degrees to the view in FIG. 17.

FIG. 19 is an end view of the probe of FIGS. 17 and 18, taken in thedirection of the arrow 19 in FIG. 17.

FIG. 20 is an end view of the probe of FIGS. 17 and 18, taken in thedirection of 25 the arrow 20 in FIG. 17.

FIG. 21 is an enlarged fragmentary view in elevation of the distal endof the shaft and the tip on the distal end in the embodiment of probeshown in FIGS. 17-20.

FIG. 22 is a further enlarged fragmentary end view of the probe of FIG.21, taken in the direction of the arrow 22 in FIG. 21.

FIG. 23 is a slightly enlarged fragmentary side view in elevation of thearea indicated generally by the bracket 23 in FIG. 21.

FIG. 24 is a sectional view taken along line 24-24 in FIG. 19.

FIG. 25 is a sectional view taken along line 25-25 in FIG. 19.

FIG. 26 is a fragmentary longitudinal sectional view of anotherembodiment of pedicle probe according to the invention.

FIG. 27 is a fragmentary top isometric view of the probe of FIG. 26.

FIG. 28 is an end view in elevation of the probe of FIG. 26, lookingfrom the left hand side of FIG. 26.

FIG. 29 is a side view, shown partially in section and partially inelevation, of a further modified probe according to the invention,wherein channels are formed in the outer surface of the probe shaft andfeeds for the light, camera and flushing liquid are placed in thesechannels, with a surrounding sleeve placed over the shaft to secure theparts in place.

FIG. 30 is a transverse sectional view taken long line 30-30 in FIG. 29.

FIG. 31 is a transverse sectional view taken long line 31-31 in FIG. 29.

FIG. 32 is an exploded isometric view, with portions broken away, of theprobe and sleeve of FIGS. 29-31.

FIG. 33 is a fragmentary enlarged sectional view of the distal end of afurther embodiment of the invention wherein a removable tip is held inplace by a set screw and is aligned in proper position by a keyway.

FIG. 34 is a transverse view in section taken along line 34-34 in FIG.33.

FIG. 35 is a transverse view in section taken along line 35-35 in FIG.33.

FIG. 36 is a longitudinal sectional view of a further embodiment of theinvention, taken along line 36-36 in FIG. 37, wherein two endoscopes areassociated with the probe, and a light means and saline flush means areprovided for illuminating the area being treated and for flushing awaydebris to maintain a clear field of view.

FIG. 37 is an enlarged end view looking in the direction of the arrow 37in FIG. 36.

DETAILED DESCRIPTION

Referring more specifically to the drawings, a conventional Fox pedicleprobe is depicted at 10 in FIG. 2. The probe has a disc-shaped head 11on its proximal end that is about two inches in diameter, and a solidmetal shaft 12 projecting from the center of one side thereof. A reduceddiameter tip 13 on the distal end of the shaft is configured to act as areamer, i.e., it may have a fluted configuration as found on drill bits.In use, a surgeon places the disc-shaped head 11 in the palm of his orher hand, with the shaft extending forwardly. The tip is then pushedagainst the pedicle while the probe is being rotated back and forthabout the longitudinal axis of the shaft to form a hole in the pediclefor reception of a pedicle screw. See, for example, FIGS. 9-14.

In the specific embodiment illustrated and described herein, the pedicleprobe 20 of the invention, as shown in FIGS. 1 and 3-15, is based on theFox pedicle probe of FIG. 2. However, it should be understood that theprobe 20 could be based on other commercially available probes, or couldembody a completely new design. The disc-shaped head 11′ of the probe 20has an opening 21 formed in it for receipt of a fiber optic cable orendoscope 22, which is connected with a suitable conventional monitor23. Similarly, the shaft 12′ has a bore 24 formed through its length forreceipt of the fiber optic cable or endoscope 22, which terminates inthe tip 13′ at a lens 25. As in conventional pedicle probes, such as theFox pedicle probe, the tip 13′ is adapted to penetrate the hard bonytissue of a vertebral pedicle to form a hole for reception of a pediclescrew.

As shown in the drawings, the tip has a substantially uniform diameterthrough a portion of its length, and terminates in a sharpened point.The diameter of the tip is approximately the same as, or slightlysmaller than, the diameter of a pedicle screw to be inserted in the holeformed with the probe, and will form an elongate hole having a uniformdiameter for secure engagement with a screw inserted in the hole. Thetip has a hardness and configuration to act as a reamer, and preferablyhas a fluted configuration as incorporated, for example, in aconventional Fox pedicle probe, to facilitate penetration of the probethrough the hard bony tissue.

As shown in FIGS. 4, 5, and 6, respectively, the tip 13′ or 13″ or 13′″can be configured to position the lens 25 for providing a 90° view (FIG.4), or a 45° forward view (FIG. 5), or a 0° view straight ahead (FIG.6). Thus, by selection of an appropriate probe, or by appropriatemanipulation of a probe, the surgeon can obtain a direct visualindication of the exact position of the probe in the pedicle and of thepedicle itself and surrounding structure. As depicted in these FIGS.,the lens is placed rearwardly of the distal point of the end to protectit when the probe is pressed against and pushed through hard bonytissue. An obturator, not shown, may be provided to close the openingthrough the side of the tip and protect the lens 25.

A second embodiment of probe 30 is shown in FIG. 15. In thismodification, a suitable light 31 is placed at the distal end of theshaft 12′ adjacent the base end of the tip 13′. The light 31 isconnected via fiber optics 32 or other suitable means extended throughthe shaft 12′ and connected with a suitable light source (not shown)external of the probe, and may be positioned to face axially forwardlyof the shaft, as shown in FIG. 15, or at an angle to the longitudinalaxis of the probe. In use, the light illuminates the pedicle in the areabeing treated to provide the surgeon with enhanced visibility of thearea as observed through the lens 25 of the endoscope 22.

FIG. 16 depicts a third embodiment 40 of pedicle probe in which the tip41 is removable. In the example shown, the removable tip has a threadedconnection 42 with the shaft 12″, but other means (not shown) ofsecurely removably attaching the tip 41 to the shaft could be utilized.The removable tip may be made of any suitable material, including carbonfiber, and enables tips with different designs to be used on the probeand also enables the tip to be replaced if it becomes worn or damagedduring use, thereby avoiding the necessity of having to replace ordispose of the entire probe. The removable tip may be used withouteither the endoscope of FIGS. 3-6 or the light of FIG. 15, or it may beused in combination with either or both the endoscope and light, shownas optional features in broken lines at 25 and 31 in FIG. 16.

FIGS. 7 and 8 are axial and sagittal views, respectively, of a pedicleP, and FIGS. 9-14 are schematic illustrations of how a probe 20 might beused to form a hole in the pedicle. Thus, and as seen especially inFIGS. 10-14, the probe is pushed through the pedicle to form a hole forreception of a pedicle screw (not shown). Depending upon the structureof the tip 13′, the probe also may be rotated back and forth to assistin forming the hole. Great care must be exercised to ensure that theprobe stays within the pedicle and does not break through the wall, ordoes not go too deep.

A fourth embodiment 50 of pedicle probe according to the invention isshown in FIGS. 17-25. The probe 50 has an enlarged generally disc-shapedhead 51 on its proximal end for grasping by the surgeon as in theprevious embodiments, an elongate reduced diameter shaft 52 projectingfrom the center of one side of the head, and a further reduced diametertip 53 extending coaxially from the distal end of the shaft. The headcomprises a circumferential rim 54 connected to the proximal end of theshaft 52 by at least two spokes 55A and 55B that join the rim with a hub56 on the proximal end of the shaft. The outer surface of the rim islongitudinally fluted at 57, and two circumferentially spaced recesses58 and 59 are formed in the upwardly facing proximal end surface 60 ofthe rim. As used herein, “upwardly facing” refers to the orientationwhen the probe is in its operative position during use. In theparticular construction shown, the recesses are in alignment withrespective flutes 57 and are circumferentially spaced apart 90 degrees.Two bores 61 and 62 are formed longitudinally through the hub and shaftin positions oriented respectively on a radius extending through arespective recess 58 or 59. One of the bores 62 exits the distal end ofthe shaft in an axially forwardly facing shoulder 63 between the baseend of the tip and the adjacent end of the shaft. The other bore 61 endsin a slot 64 formed in the side of the shaft at its distal end andextending angularly at an angle β of 16 degrees relative to thelongitudinal axis of the shaft into the base end of the tip. A bore 65extends from the slot and diagonally through the tip to exit an oppositeside of the tip, providing a view extending over an angle α of 74degrees.

A fifth embodiment 70 of pedicle probe according to the invention isshown in FIGS. 26-28. In this embodiment, the proximal end or head 71 ofthe probe has a central opening 72 extending inwardly from its axiallyupwardly facing surface 73, and a plurality of bores 74, 75, and 76extend longitudinally through the shaft 77 from the base of the opening.A radial notch 78 in the axially upwardly facing surface connects thecentral opening with the outer circumference of the head. An endoscope22, light 31, and conduit 79 for conveying a flushing fluid to thedistal end of the probe to remove body fluids and debris from the areabeing worked on extend through the notch 78 and through the bores 74,75, and 76, respectively. Although not shown in FIGS. 26-28, the bores74, 75 and 76 could exit through the shoulder between the base end ofthe tip and the distal end of the shaft (see, e.g. shoulder 63 in FIGS.24 and 25), or the endoscope bore could terminate in a slot such as slot64 seen in FIGS. 21-23. Also not shown in FIGS. 26-28, the tip could beintegrally formed with the shaft as seen in FIGS. 17-25 or it could bedetachable as seen in FIG. 16.

A sixth embodiment 80 of pedicle probe according to the invention isshown in FIGS. 29-32. In this form of the invention, rather than extendbores longitudinally through the body of the shaft for containing theendoscope, light, and conduit for the flushing fluid, longitudinallyextending channels 81, 82, and 83 are formed in the outer surface of theshaft 84, and a cylindrical sleeve 85 is positioned in snug relationshipover the shaft in enclosing relationship to the channels and theendoscope 22, light 31, and conduit 79 held therein. As in the previousembodiments, the tip may be integral with the shaft or detachable.Similarly to the embodiment shown in FIGS. 26-28, the head 71′ has acentral opening 72′ and the endoscope 22, light 31, and flushing conduit79 are fed through a notch 78′ in the end surface of the head.

A seventh embodiment 90 of pedicle probe according to the invention isshown in FIGS. 33-35. In this form of the invention, the tip 91 isdetachably secured to the distal end of the shaft 92 by a set screw 93extended through the side of the shaft and into engagement with the baseend 94 of the tip, which is inserted into an axial bore 95 in the distalend of the shaft. Proper rotational positioning of the tip relative tothe shaft is achieved by a keyway formed by an axially extending grooveor slot 96 in the interior surface of bore 95 and a complementallyshaped key 97 on the exterior of the base end 94 of the tip. The tip maybe readily detached from the shaft by loosening the set screw and may beused with any of the previous forms of the invention. An endoscope 22and/or a light 31 and/or a conduit 79 for flushing fluid, all shown inFIGS. 33-35, may be used in combination with the detachable tip, or thedetachable tip may be used without any of these. As seen in FIG. 35, theoutlet for the flushing fluid may have numerous small orifices 98 toprovide a “soft” flow of flushing fluid against the area being treated.

An eighth embodiment 100 of probe according to the invention is shown inFIGS. 36 and 37. In this embodiment, a first endoscope 101 and a secondendoscope 102 are provided in the probe. The first endoscope 101 has afirst camera 103 positioned at the distal end of the tip 104 in a zerodegree forwardly facing orientation. The second endoscope 102 has asecond camera 105 positioned at the distal end 106 of the probe shaft107 and oriented in a camera window slot 108 to provide about a 70° viewlooking at the side of the pedicle wall. A bright fiber optic lightsource 109 is positioned at the distal end of the probe shaft adjacentthe window for the camera 105. The light illuminates the pedicle andsurrounding bony structures which will give visualization within thecancellous portion of the pedicle. A saline rinse port 110 alsopreferably is provided at the distal end of the probe shaft to rinseaway debris during use of the probe to keep the field of vision clear.

One example of a suitable endoscopic camera for use in the probe of theinvention is the 1.2 mm micro camera available from Medigus, Ltd. ofOmer, Israel. This camera has a diameter of only 1.2 mm and a length ofonly 5 mm. It has high quality 100 degree FOV optics and a shieldedcamera cable with a metal connector as well as a video processor.

In a typical example of a probe made in accordance with the invention,the shaft can have a length of about 28 cm and a diameter of from about6 mm to about 12 mm; the tip can have a length of about 40 mm and adiameter of from 4 mm to about 5 mm; and the endoscope 22, light 32, andconduit 79 for flushing fluid each can have a diameter of from about 1mm to about 2 mm. In those embodiments wherein the camera for theendoscope is located adjacent the proximal end of the tip, it can beplaced along the tip a distance spaced approximately 6 mm to 8 mm fromwhere the tip is joined to the end of the shaft, and preferably isoriented at an angle of 45 degrees to 90 degrees relative to thelongitudinal axis of the tip. It should be noted that these areexemplary dimensions only and the probe and its components could haveother dimensions as necessary or desirable.

The endoscopic probe of the invention provides the surgeon with anilluminated, direct visual indication of the exact location of the probeand provides for flushing body fluids and debris away from the areabeing treated, whereby the hole can be formed with accuracy andprecision.

While particular embodiments of the invention have been illustrated anddescribed in detail herein, it should be understood that various changesand modifications may be made to the invention without departing fromthe spirit and intent of the invention as defined by the scope of theappended claims.

1. A probe comprising: an enlarged proximal end for cooperation with thehand of a surgeon using the probe to aid in controlling the probe; anelongate shaft having a longitudinal axis and extending from theenlarged proximal end to a distal end; a reduced diameter tip at thedistal end of the shaft, the tip having a hardness and configurationadapted to be pushed through a vertebral pedicle to form a hole forreception of a pedicle screw; a first bore extending longitudinallythrough the shaft and through the tip, and a first endoscope associatedwith the first bore, the first endoscope including a camera positionedat a distal end of the tip and being connected with a first endoscopicmonitor to provide the surgeon with a first direct view of an area beingtreated; a second bore extending longitudinally through the shaft and alight associated with the second bore to illuminate the area beingtreated; and a third bore extending longitudinally through the shaft,and a conduit extending through the third bore for conveying a fluid tothe area being treated to flush away from the area body fluid and debristhat would otherwise obscure the area being treated, wherein the tip isdetachable from the shaft, whereby the detachable tip enables a damagedor worn tip to be replaced, or a tip with different characteristics tobe employed, without replacing the entire probe.
 2. The probe of claim1, further comprising a fourth bore extending longitudinally through theshaft, and a second endoscope associated with the fourth bore, thesecond endoscope including a camera positioned at the distal end of theshaft and being connected with a second endoscopic monitor to providethe surgeon with a second direct view of the area being treated.
 3. Theprobe of claim 2, wherein the first endoscopic monitor and the secondendoscopic monitor are the same.
 4. The probe of claim 1, wherein thedetachable tip is threadably attached to the shaft.
 5. The probe ofclaim 4, wherein the detachable tip has a base end received in an axialbore in the center of the distal end of the shaft, and wherein a setscrew extends through a side of the shaft into engagement with the tipbase end to hold the tip in the axial bore.
 6. The probe of claim 5,wherein a coaxial bore in the base end of the tip is in axial alignmentwith the first bore in the shaft, and wherein the coaxial bore in thebase end of the tip connects with an angularly extending diagonal boreopening through a side of the tip, the camera of the first endoscopebeing positioned in the diagonal bore where it exits through the side ofthe tip.
 7. The probe of claim 6, wherein the second and third boresopen through the distal end of the shaft in rotationally spacedrelationship to one another, the tip being rotationally orientedrelative to the shaft so that the light is positioned on the same sideof the probe as the diagonal bore and the camera of the first endoscope.8. The probe of claim 7, wherein a keyway is formed between the base endof the tip and the coaxial bore in the shaft to rotationally orient thetip when it is attached to the shaft so that the light is positioned onthe same side of the probe as the diagonal bore and the camera of thefirst endoscope.
 9. A system for performing a surgical procedure in anarea being treated, the system including a probe, the probe comprising:an enlarged proximal end for cooperation with the hand of a surgeonusing the probe to aid in controlling the probe; an elongate shafthaving a longitudinal axis and extending from the enlarged proximal endto a distal end; and a plurality of tips, each of the tips beingoperable to removably attach to the distal end of the shaft, wherein atleast one of the tips has a hardness and configuration adapted to bepushed through a vertebral pedicle to form a hole for reception of apedicle screw.
 10. The system of claim 9, wherein the probe furthercomprises a bore extending longitudinally through the shaft, and anendoscope associated with the bore, the endoscope including a camerapositioned at the distal end of the shaft and being connected with anendoscopic monitor to provide the surgeon with a direct view of the areabeing treated.
 11. The system of claim 9, wherein the probe furthercomprises a bore extending longitudinally through the shaft and throughthe tip, and an endoscope associated with the bore, the endoscopeincluding a camera positioned at the distal end of the tip and beingconnected with an endoscopic monitor to provide a surgeon with a directview of the area being treated.
 12. The system of claim 11, wherein theprobe further comprises a second bore extending longitudinally throughthe shaft and a light associated with the second bore to illuminate thearea being treated.
 13. The system of claim 12, wherein the probefurther comprises a third bore extending longitudinally through theshaft and a conduit extending through the third bore for conveying afluid to the area being treated to flush away from the area body fluidand debris that would otherwise obscure the area being treated.
 14. Thesystem of claim 9, wherein the probe further comprises a firstlongitudinally extending channel formed in an outer surface of theshaft; an endoscope extending through the proximal end and through thefirst channel, the endoscope including a camera at the distal end of theshaft; and a cylindrical sleeve telescoped over the shaft and over thefirst channel and endoscope positioned therein.
 15. The system of claim14, wherein the probe further comprises a second longitudinallyextending channel formed in the outer surface of the shaft; and a lightmeans extending through the proximal end and through the second channelto illuminate an area viewed by the endoscope.
 16. The system of claim15, wherein the probe further comprises a third longitudinally extendingchannel formed in the outer surface of the shaft and a conduit extendingthrough the third channel for conveying a fluid to the area beingtreated to flush away from the area body fluid and debris that wouldotherwise obscure the area being treated.